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Safety of Outpatient Parenteral Antimicrobial Therapy in Children
Insights
Outpatient parenteral antimicrobial therapy (OPAT) in children carries risks. Oxacillin use increased discontinuation, while clindamycin and peripherally inserted central catheters led to more outpatient visits.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Patient Safety in OPAT
Background:
- Outpatient parenteral antimicrobial therapy (OPAT) offers benefits but presents unique risks for pediatric patients.
- Understanding these risks is crucial for optimizing pediatric OPAT protocols.
Purpose of the Study:
- To determine the rates of complications associated with OPAT in children.
- To investigate the association between specific antimicrobials and intravenous access types with OPAT-related complications.
Main Methods:
- An observational cohort study was conducted on pediatric patients receiving OPAT.
- Data were collected from August 2008 to May 2015 at a tertiary children's hospital.
- Primary outcome was antimicrobial discontinuation due to complications; secondary outcomes included unplanned healthcare visits and readmissions.
Main Results:
- Complications led to antimicrobial discontinuation in 23% of cases.
- Oxacillin use was linked to a higher risk of discontinuation and hepatic transaminitis compared to ceftriaxone.
- Clindamycin and peripherally inserted central catheters were associated with increased unplanned outpatient visits.
Conclusions:
- Oxacillin use in pediatric OPAT is associated with a higher rate of antimicrobial discontinuation.
- Clindamycin and peripherally inserted central catheters increase the likelihood of unplanned outpatient visits.
- Alternative treatment options should be strongly considered to mitigate OPAT-related risks in children.
Background And Objective:
Outpatient parenteral antimicrobial therapy (OPAT) provides numerous benefits but may pose unique risks in children. We aimed to determine rates of OPAT antimicrobial- and intravenous access-related complications and their associations with specific antimicrobials and type of intravenous access in pediatric patients.
Methods:
Observational cohort study of patients receiving OPAT from August 2008 to May 2015 cared for by the Infectious Diseases service at a tertiary children's hospital. Primary outcome was antimicrobial discontinuation (AD) because of OPAT-associated complications. Secondary outcomes were unplanned outpatient healthcare visits and readmissions from OPAT-associated complications.
Results:
Seven hundred and seven intravenous antimicrobials were prescribed in 540 cases. Nondevice-associated musculoskeletal infection was the most common diagnosis (39%). Ceftriaxone (30%), cefazolin (27%) and vancomycin (22%) were the most commonly used antimicrobials. Complications led to AD, ≥1 unplanned outpatient healthcare visit and ≥1 readmission in 23%, 30% and 17% of cases, respectively. Compared with use of ceftriaxone, use of oxacillin was associated with a significantly higher risk of AD because of any antimicrobial-related complication [hazard ratio (HR), 3.3; 95% confidence interval (CI): 1.2-9.7) and because of hepatic transaminitis (HR, 32.8; 95% CI: 4.02-268.2). Subjects treated with intravenous clindamycin (HR, 2.6; 95% CI: 1.1-5.8) and with a peripherally inserted central catheter (HR, 2.6; 95% CI: 1.04-6.3) were more likely to have unplanned outpatient visits.
Conclusions:
Use of oxacillin during OPAT was associated with higher rate of AD. Patients treated with clindamycin and those with a peripherally inserted central catheter had higher rates of unplanned outpatient visits. Providers should strongly consider alternative treatment options when possible.
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